Deverall P B, Olley P M, Smith D R, Watson D A, Whitaker W
Thorax. 1968 Sep;23(5):530-6. doi: 10.1136/thx.23.5.530.
Mitral valvotomy is of established value in improving the clinical condition and life expectancy of patients with rheumatic mitral stenosis. Its value in preventing or reducing the incidence of systemic arterial embolism is less certain. A comparison of pre- and post-operative embolic incidence can only be accepted if it is clear that the method of assessing the pre-operative figure is reliable. It is shown that the figure varies according to the length of the pre-operative study, and evidence is presented to show a changing incidence with increasing length of chronic rheumatic history. By studying patients in whom the time of onset of rheumatic heart disease is accurately known, a rising embolic incidence with the passage of time is shown. A comparison is made between groups of patients who have experienced the same length of chronic rheumatic history but who differ in respect of mitral valvotomy. We conclude from our comparison that this operation does not diminish the incidence of embolism, though only about a quarter of all our patients had atrial appendagectomy at the time of valvotomy. A reduction in the incidence of recurrent embolism in a given patient after mitral valvotomy is shown but may be more apparent than real. Operative embolism, defined here as that occurring either at or within 48 hours of operation, has an incidence of 3·8%. The factors related to pre-operative, operative, and post-operative embolism are presented.
二尖瓣切开术在改善风湿性二尖瓣狭窄患者的临床状况和预期寿命方面具有公认的价值。其在预防或降低系统性动脉栓塞发生率方面的价值尚不确定。只有在明确术前评估方法可靠的情况下，术前和术后栓塞发生率的比较才是可接受的。研究表明，该数值会因术前研究时长的不同而变化，并且有证据表明随着慢性风湿病史时长的增加，栓塞发生率也会发生变化。通过对风湿性心脏病发病时间确切已知的患者进行研究，发现栓塞发生率会随着时间推移而上升。对患有相同时长慢性风湿病史但接受二尖瓣切开术情况不同的患者组进行了比较。我们从比较中得出结论，尽管在我们所有患者中只有约四分之一在二尖瓣切开术时进行了心耳切除术，但该手术并未降低栓塞发生率。二尖瓣切开术后特定患者复发性栓塞发生率有所降低，但这可能更多是表面现象而非实际情况。本文定义的手术栓塞是指在手术时或手术后48小时内发生的栓塞，发生率为3.8%。文中还介绍了与术前、术中及术后栓塞相关的因素。
